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Wednesday, 27 February 2013

Clinical Question

I recently was referred a 14 year old boy with ASD for concerns about having erections and touching himself in public/school. I generally work with kids under 8 and not at all with ASD so I’m a bit out of my realm. The behaviour specialist from the school has recommended to cue him with “Stop” but this is not working. The family is finding that they are limiting their social outings because of this concern and are open to any suggestions. Any ideas?

4 comments:

It's always difficult to manage a behavior like this one, and adding ASD into the equation is even more challenging! I have experienced this with children with tic disorders and many special needs persons have tics, so to speak. Not knowing this youth, whether he is easy to reidrect or not.How often does it happen? what is going on before an episode? Can he be redirected to remove himself from the public i.e. go to a private area or washroom if he really must fulfill the touching he is seeking. Using a cue - could be a hand signal or code word.Just some ideas! Good luck and post if you have had any success and what you have found to work.Can a replacement be used to give him the same tactile input he is seeking, in an appropriate way?I would try looking at it from this standpoint.

I would start by making sure he understands the difference between a "public" and a "private" location, as well as the fact that different activities are "public" and "private". I have started by just classifying various pictures as public vs private. Once the child has an understanding of these terms, I have used visual cues to remind the kids that masturbation is a private activity. Sometimes I will just have the parent or teacher carry a "That's private" visual cue and they can hand it to the kid as a reminder to ask to be excused to the bathroom. I would be interested in any strategies that you find useful as well. This can be a challenging behaviour to address.

If he responds well to social stories you could create one around when and where masturbation is appropriate. You could then provide him with a few other sensory strategies that he can choose when he is out in public to replace the masturbating.

I agree with the ideas above. It really depends upon the level and understanding of the student as to what strategies might be most effective. For a lower functioning student, redirecting with other objects and providing private time might be appropriate. Pairing visual supports and social stories is a great idea. Visual supports could be cards that accompany the social story and can be given to him at times to cue him that the behaviour is not appropriate.If the child has higher understanding, teaching social "rules" would be important. The public vs private behaviour and options for what he can do instead. Jed Baker has a good book geared for adolescents. I think that the title is called Preparing for Life (or something like that) I believe it has a discussion about masturbation in it.

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